New dental plan cuts fees for member dentists

SPRINGFIELD -- More dentists may be requiring upfront payment from patients in response to a new dental plan for state of Illinois employees, retirees and dependents, but few patients are complaining.

DEAN OLSEN

SPRINGFIELD -- More dentists may be requiring upfront payment from patients in response to a new dental plan for state of Illinois employees, retirees and dependents, but few patients are complaining.

The new contract with Delta Dental of Illinois, which began July 1, will pay the not-for-profit group $12.3 million over the five-year contract to process between $110 million and $115 million a year in dental claims for about 350,000 people statewide.

The agreement is expected to save the state $8 million to $10 million annually in claims through the use of managed-care networks that weren’t part of the previous contract with CompBenefits, according to Januari Smith, spokeswoman for the Illinois Department of Healthcare and Family Services.

The savings would be generated by payment discounts of 15 percent to 30 percent that dentists must accept if they want to be in one of the networks, said Greg Johnson, executive director of the Illinois State Dental Society.

Reduced fees

The state’s basic dental benefit isn’t changing. But Delta Dental chief executive Bernie Glossy said the new networks can be attractive to patients because the plans will result in fewer out-of-pocket costs, and the reduced fees allow patients to stretch their maximum $2,500 annual benefit for all dental services.

Under the old system, dentists billed the state for their services and were free to bill above what the state would pay. Dentists could bill the patient upfront or wait for payment, and reimbursement checks from the state would go directly to dentists.

Under the new system, dentists who belong to one of the managed-care networks — either Delta Dental PPO or Delta Dental Premier — must accept what the state pays and not bill patients extra. They continue to receive reimbursement checks.

However, dentists not in the networks don’t receive reimbursements directly — their patients receive the checks. This is the way Naperville-based Delta also handles reimbursement for non-network dentists in other employers’ plans, Glossy said.

He said he doesn’t know whether more dentists will demand upfront payment as a result of the new setup. He said Delta Dental has received few, if any, complaints from patients.

Top officers in the G.V. Black Dental Society did not return calls from The State Journal-Register.

Upfront payments

Springfield dentist Brandon Maddox said he decided not to join one of the Delta networks because of the size of the discounts required. He said his office, like most dental offices, spends 60 percent to 70 percent of its revenues on overhead.

Maddox requires patients in the state plan to pay 100 percent of their bills upfront or get a loan to do so. However, he said he gives patients a 5 percent discount if they pay the entire bill on the spot.

“We’re making it work for my patients,” Maddox said. “I don’t want to strain my patients’ pocketbooks any more than I have to.”

Maddox, who said at least half of his patients are covered by the state’s plan, believes that most other Springfield dentists not in the Delta networks also are requiring upfront arrangements.

Most patients have been understanding, he said, and many are upset with the state’s long delays in payments to dentists.

“From a standpoint of a business person, the way the state is functioning is unacceptable,” Maddox said. “The state employees are the ones who suffer.”

State delays

Maddox estimated the state’s payment delays average more than seven months, a factor in his decision to require upfront arrangements.

Delta Dental contends that 75 percent of the state’s dentists are members of one of Delta’s networks. Johnson, however, believes that perhaps half of Illinois dentists, and less than half of Springfield dentists, are in the networks.

Hank Scheff, director of employee benefits for Chicago-based Council 31 of the American Federation of State, County and Municipal Employees, said he has heard few complaints from state employees about the new dental contract.

He said he doesn’t believe the practice of non-network dentists requiring payment upfront is any more widespread than under the former dental plan, but he doesn’t know for sure.

Scheff said dentists don’t have any more reason to request upfront payments now, as long as they trust their patients to pay their bills.